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Editorial
Medical Misinformation
Vet the Message!
Joseph A. Hill1
1Department of Internal Medicine, University of Texas Southwestern
Medical Center, Dallas, Texas, United States
Thorac Cardiovasc Surg 2019;67:80–82.
“Mrs. Jones, based on your risk factors for having a heart
attack, I recommend that we start you on a statin.”
“No,thankyou,Doctor,I’ve read too many scary things
about those drugs on the internet. Plus, I worry that
some in your profession make these recommendations for
reasons of personal financial gain. I also found that
online.”
Undoubtedly, the majority of cardiologists have had
conversations just like this, urging a patient to take a
statin, a powerful cholesterol-lowering drug with robust
mortality benefit. Part of the reason these oftentimes no-
brainer recommendations are rejected derives from widely
disseminated incorrect information that vastly over states
the risks of these drugs. (Of course, like anything in life, the
use of statins is not entirely risk-free; their application
should always entail a thoughtful analysis of risks vs.
benefits.) Most patients do not recognize that the benefits
of statin use are invisible (“Ididn’t have a heart attack or
stroke this past year”), whereas the small and typically
reversible risks (e.g., muscle pain) are readily apparent.
Many patients who would benefitfromstatinusedonot
take them.
Cardiovascular disease is the no. 1 killer of both men and
women around the world. Robust scientific advances, pub-
lished in the pages of our journals, have fostered significant
improvements that benefitindividualsandsociety.Yet,
cardiovascular disease continues to transform itself, emer-
ging in new forms, such as heart failure. The struggle has
shifted to new battlefields.
These successes derive from an armamentarium of power-
ful tools, medicines,devices, and awareness of lifestyle-related
hazards, such as high blood pressure, high cholesterol, and
smoking. Sadly, however, we do not take full advantage of the
tools at our disposal.
One significant cause of suboptimal utilization of our
prodigious tool chest is medical misinformation hyped
through the internet, television, chat rooms, and social
media. In many instances, celebrities, activists, and politi-
cians convey false information; not uncommonly, authors
with purely venal motives participate.
We can point to numerous other examples, including the
entirely unfounded concerns regarding vaccinations. The
notion that MMR (measles, mumps, rubella) vaccination
causes autism was based on a single flawed study, long
since refuted, with its publication retracted. Seventeen
much larger and properly controlled studies have proven
otherwise. Nevertheless, the internet shouts unfounded
warnings. Once again, celebrities, actors, activists, and
politicians with no specific knowledge or training use their
fame to promote a message that causes serious harm.
Individuals who are neither physicians nor scientists, but
often with a specific agenda, have outsized influence over
our lives. They dispute scientific evidence without ever
having studied it.1
Recognizing that it is impossible to prove “never,”scientists
appropriately couch their statements in statistical terms which
may come across to the public as equivocation. The nuanced
Keywords
►editorials
►cardiovascular diseases
►communication
►hydroxymethylglutaryl-CoA inhibitors
►information dissemination
►social
►media
►vaccination
Address for correspondence
Joseph A. Hill, MD, PhD,
Department of Internal Medicine,
University of Texas Southwestern
Medical Center, NB11.200, UT
Southwestern, 6000 Harry Hines
Boulevard, Dallas, TX 75390-
8573, United States
(e-mail: joseph.hill@
utsouthwestern.edu).
DOI https://doi.org/
10.1055/s-0039-1678544.
ISSN 0171-6425.
received
December 11, 2018
accepted
December 11, 2018
published online
January 29, 2019
The article has been co-published with
permission in Circulation and The Thoracic
and Cardiovascular Surgeon. All rights
reserved in respect of Circulation, © the
Authors 2019. For The Thoracic and
Cardiovascular Surgeon, © the Authors
2019. Published by Thieme Group
Editorial
THIEME
80
Published online: 2019-01-29
voices of scientists often do not resonate with the public as
much as the strident alarms sounded by people of fame, speak-
ing in absolute terms.
Furthermore, scientists are appropriately skeptical
because any individual scientist or study can be wrong.
Yet, science ultimately self-corrects. When a scientist gets
it wrong, as happens, people sometimes vilify the entire self-
correcting scientific enterprise. We trust aeronautical
science when we board an airplane; we trust the science
buried within our cell phones; we trust mechanical engi-
neering science when we cross a bridge; yet, many are
uniquely skeptical of biological science.
Sadly, we cannot exclude that some in the professions of
science and medicine act based on motives driven by finan-
cial considerations; incomplete declarations of potential
conflict of interest persist.2Recent examples of dramatic
price hikes for important medications have reinforced this
notion. Indeed, many physicians have had conversations
with patients who believe that our recommendations
stem, at least in part, from the prospect of personal financial
gain.
We, the editors-in-chief of the major cardiovascular scien-
tific journals, around the globe, sound the alarm that human
lives are at stake. Pointing to the two examples elaborated
above, people who decline to use a statin when recom-
mended by their doctor, or parents who withhold vaccines
from their children, put lives in harm’sway.
The media must do a better job. It is unacceptable to posit
false equivalents in these discussions, often done to foster
debate and controversy. It is easy to find a rogue voice but
inappropriate to suggest that voice carries the same weight
as that emerging from mainstream science. (We can easily
point to examples outside the medical domain, as well, such
as climate change, evolution, nutraceuticals, and genetically
modified foods, where false equivalents are frequently pos-
ited.) Furthermore, recent evidence suggests that misinfor-
mation travels faster through social networks than truth.3
We must work to enhance science literacy in our world; one
place to start is by doing a better job of teaching the scientific
method in our schools so that the lay public is aware that
science is accomplished in fits and starts, but, in the end, gets
it right.
Purveyors of social media must be responsible for the
content they disseminate. It is no longer acceptable to hide
behind the cloak of platform. We, as editors, are charged
with evaluating the validity of the science presented to us
for possible publication, and we work hard to fulfill this
heady responsibility. Recognizing that lives are at stake, we
reach out to thought-leading experts to evaluate the
veracity of each report we receive. Here, we challenge
social media to do the same, to leverage the ready avail-
ability of science-conversant expertise before disseminat-
ing content that may not be reliable. Without exaggeration,
significant harm, to society and individuals, derives from
the wanton spread of medical misinformation. It is high
time that this stop, and we lay at the feet of the purveyors
of internet and social media content the responsibility to
fixthis.
Article Information
Authors
Joseph A. Hill, MD, PhD, Editor-in-Chief, Circulation;Stefan
Agewall, MD, PhD, Editor-in-Chief, European Heart Journal
Cardiovascular Pharmacotherapy; Adrian Baranchuk, MD,
Editor-in-Chief, Journal of Electrocardiology; George W.
Booz, PhD, Editor-in-Chief, Journal of Cardiovascular Phar-
macology; Jeffrey S. Borer, MD, Editor-in-Chief, Cardiology;
Paolo G. Camici, MD, Editor-in-Chief, International Journal of
Cardiology; Peng-Sheng Chen, MD, Editor-in-Chief, Heart-
Rhythm; Anna F. Dominiczak, DBE, MD, Editor-in-Chief,
Hypertension; Çetin Erol, MD, PhD, Editor-in-Chief, Anatolian
Journal of Cardiology; Cindy L. Grines, MD, Editor-in-Chief,
Journal of Inter ventional Cardiology; Robert Gropler, MD,
Editor-in-Chief, Circulation: Cardiovascular Imaging;Tomasz
J. Guzik, MD, PhD, Editor-in-Chief, Cardiovascular Research;
Markus K. Heinemann, MD, PhD, Editor-in-Chief, The Thor-
acic and Cardiovascular Surgeon; Ami E. Iskandrian, MD,
Editor-in-Chief, Journal Nuclear Cardiology;BradleyP.
Knight, MD, Editor-in-Chief, PACE and EPLab Digest;Barry
London, MD, PhD, Editor-in-Chief, Journal of the American
Heart Association; Thomas F. Lüscher, MD, Editor-in-Chief,
European Heart Journal; Marco Metra, MD, Editor-in-Chief,
European Journal of Heart Failure; Kiran Musunuru, MD, PhD,
MPH, Editor-in-Chief, Circulation: Genomic and Precision
Medicine; Brahmajee K. Nallamothu, MD, MPH Editor-in-
Chief, Circulation: Cardiovascular Quality and Outcomes
Andrea Natale, MD, and Sanjeev Saksena, MD, Editors-in-
Chief, Journal of Inter ventional Cardiac Electrophysiology;
Michael H. Picard, MD, Editor-in-Chief, Journal of the American
Society of Echocardiography; Sunil I. Rao, MD, Editor-in-Chief,
Circulation: Cardiovascular Interventions;WillemJ.Remme,
MD, PhD, and Robert S. Rosenson, MD, Editors-in-Chief, Cardi-
ovascular Drugs and Therapy; Nancy K. Sweitzer, MD, PhD,
Editor-in-Chief, Circulation: Heart Failure; Adam Timmis, MD,
Editor-in-Chief, European Heart Journal: Quality of Care and
Clinical Outcomes; Christiaan Vrints, MD, PhD, Editor-in-Chief,
European Heart Journal: Acute Cardiovascular Care.
Disclaimer
The opinions expressed in this article are not necessarily
those of the editors or of the American Heart Association.
Disclosures
P.G. Camici is consultant for Servier. R.S. Rosenson reports
research grants to his institutions from Akcea, Amgen,
Astra Zeneca, Medicines Company and Regeneron.
R.S. Rosenson reports speaking engagements at Amgen
and Kowa, research consulting for Akcea and Regeneron,
royalties from UpToDate, Inc. and stock holdings in
MediMergent. All other authors have nothing to
disclose.
Note
A complete list of all journals publishing this article, along
withlinks to the individual articles, can be foundonline at
https://www.ahajournals.org/circ/medical-misinformation.
Thoracic and Cardiovascular Surgeon Vol. 67 No. 2/2019
Medical Misinformation Hill et al. 81
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baselga-cancer-memorial-sloan-kettering.html.AccessedDecember
11, 2018
3Vosoughi S, Roy D, Aral S. The spread of true and false news online.
Science 2018;359(6380):1146–1151
Thoracic and Cardiovascular Surgeon Vol. 67 No. 2/2019
Medical Misinformation Hill et al.82
